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Semeraro F, Monsieurs KG. Synthesizing and communicating scientific evidence into treatment recommendations using artificial intelligence: The "case" of temperature control after cardiac arrest. Resuscitation 2024; 197:110145. [PMID: 38367828 DOI: 10.1016/j.resuscitation.2024.110145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Affiliation(s)
- Federico Semeraro
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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Schnaubelt S, Greif R, Monsieurs KG. The frame of survival for cardiopulmonary resuscitation in lower resource settings - Authors' reply. Lancet Glob Health 2024; 12:e380. [PMID: 38365411 DOI: 10.1016/s2214-109x(23)00596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/11/2023] [Indexed: 02/18/2024]
Affiliation(s)
- Sebastian Schnaubelt
- Education, Implementation, and Teams Task Force, International Liaison Committee on Resuscitation, Niel, Belgium; European Resuscitation Council, Niel, Belgium; Department of Emergency Medicine, Medical University of Vienna, Vienna 1090, Austria; Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium; University of Antwep, Edegem, Belgium.
| | - Robert Greif
- Education, Implementation, and Teams Task Force, International Liaison Committee on Resuscitation, Niel, Belgium; European Resuscitation Council, Niel, Belgium; University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Koenraad G Monsieurs
- Education, Implementation, and Teams Task Force, International Liaison Committee on Resuscitation, Niel, Belgium; European Resuscitation Council, Niel, Belgium; Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium; University of Antwep, Edegem, Belgium; University of Antwerp, Antwerp, Belgium
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Semeraro F, Gamberini L, Carmona F, Monsieurs KG. Clinical questions on advanced life support answered by artificial intelligence. A comparison between ChatGPT, Google Bard and Microsoft Copilot. Resuscitation 2024; 195:110114. [PMID: 38211808 DOI: 10.1016/j.resuscitation.2024.110114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Affiliation(s)
- Federico Semeraro
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy.
| | - Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
| | | | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
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Schnaubelt S, Garg R, Atiq H, Baig N, Bernardino M, Bigham B, Dickson S, Geduld H, Al-Hilali Z, Karki S, Lahri S, Maconochie I, Montealegre F, Tageldin Mustafa M, Niermeyer S, Athieno Odakha J, Perlman JM, Monsieurs KG, Greif R. Cardiopulmonary resuscitation in low-resource settings: a statement by the International Liaison Committee on Resuscitation, supported by the AFEM, EUSEM, IFEM, and IFRC. Lancet Glob Health 2023; 11:e1444-e1453. [PMID: 37591590 DOI: 10.1016/s2214-109x(23)00302-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/19/2023]
Abstract
Most recommendations on cardiopulmonary resuscitation were developed from the perspective of high-resource settings with the aim of applying them in these settings. These so-called international guidelines are often not applicable in low-resource settings. Organisations including the International Liaison Committee on Resuscitation (ILCOR) have not sufficiently addressed this problem. We formed a collaborative group of experts from various settings including low-income, middle-income, and high-income countries, and conducted a prospective, multiphase consensus process to formulate this ILCOR Task Force statement. We highlight the discrepancy between current cardiopulmonary resuscitation guidelines and their applicability in low-resource settings. Successful existing initiatives such as the Helping Babies Breathe programme and the WHO Emergency Care Systems Framework are acknowledged. The concept of the chainmail of survival as an adaptive approach towards a framework of resuscitation, the potential enablers of and barriers to this framework, and gaps in the knowledge are discussed, focusing on low-resource settings. Action points are proposed, which might be expanded into future recommendations and suggestions, addressing a large diversity of addressees from caregivers to stakeholders. This statement serves as a stepping-stone to developing a truly global approach to guide resuscitation care and science, including in health-care systems worldwide.
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Affiliation(s)
- Sebastian Schnaubelt
- European Resuscitation Council, Niel, Belgium; Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr Braich All India Institute of Medical Sciences, New Delhi, India
| | - Huba Atiq
- Department of Anaesthesiology, Centre of Excellence for Trauma & Emergency, The Aga Khan University Hospital, Karachi, Pakistan
| | - Noor Baig
- Department of Emergency Medicine, Centre of Excellence for Trauma & Emergency, The Aga Khan University Hospital, Karachi, Pakistan
| | - Marta Bernardino
- Centro de Simulacion, Hospital Universitario Fundacion Alcorcon, Madrid, Spain; Spanish Society of Anaesthesiology and Intensive Care, Madrid, Spain
| | - Blair Bigham
- Department of Anesthesia, Division of Critical Care, Stanford University, Palo Alto, CA, USA
| | | | - Heike Geduld
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | | | - Sanjaya Karki
- Department of Emergency and Pre-hospital Care, Mediciti Hospital, Bhaisepati, Lalitpur, Nepal
| | - Sa'ad Lahri
- Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, Imperial College Healthcare Trust, London, UK
| | - Fernando Montealegre
- Department of Anaesthesiology, José Casimiro Ulloa Emergency Hospital, Peruvian Resuscitation Council, Lima, Peru
| | | | - Susan Niermeyer
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine and Colorado School of Public Health, Aurora, CO, USA
| | - Justine Athieno Odakha
- Department of Emergency Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jeffrey M Perlman
- Department of Pediatrics, Division of Newborn Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, NY, USA
| | - Koenraad G Monsieurs
- European Resuscitation Council, Niel, Belgium; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Robert Greif
- European Resuscitation Council, Niel, Belgium; University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Semeraro F, Picardi M, Monsieurs KG. "Learn to Drive. Learn CPR.": A Lifesaving Initiative for the Next Generation of drivers. Resuscitation 2023; 188:109835. [PMID: 37196803 DOI: 10.1016/j.resuscitation.2023.109835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Federico Semeraro
- Department of Anaesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy; European Resuscitation Council, Niel, Belgium.
| | - Manuel Picardi
- EFA European Driving Schools Association, Brussels, Belgium
| | - Koenraad G Monsieurs
- European Resuscitation Council, Niel, Belgium; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
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Morreel S, Verhoeven V, Philips H, Meysman J, Homburg I, De Graeve D, Monsieurs KG. Differences in emergency nurse triage between a simulated setting and the real world, post hoc analysis of a cluster randomised trial. BMJ Open 2022; 12:e059173. [PMID: 35777880 PMCID: PMC9252194 DOI: 10.1136/bmjopen-2021-059173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES In the TRIAGE trial, a cluster randomised trial about diverting emergency department (ED) patients to a general practice cooperative (GPC) using a new extension to the Manchester Triage System, the difference in the proportion of patients assigned to the GPC was striking: 13.3% in the intervention group (patients were encouraged to comply to an ED or GPC assignment, real-world setting) and 24.7% in the control group (the assignment was not communicated, all remained at the ED, simulated setting). In this secondary analysis, we assess the differences in the use of the triage tool between intervention and control group and differences in costs and hospitalisations for patients assigned to the GPC. SETTING ED of a general hospital and the adjacent GPC. PARTICIPANTS 8038 patients (6294 intervention and 1744 control).Primary and secondary outcome measures proportion of patients with triage parameters (reason for encounter, discriminator and urgency category) leading to an assignment to the ED, proportion of patients for which the computer-generated GPC assignment was overruled, motivations for choosing certain parameters, costs (invoices) and hospitalisations. RESULTS An additional 3.1% (p<0.01) of the patients in the intervention group were classified as urgent. Discriminators leading to the ED were registered for an additional 16.2% (p<0.01), mainly because of a perceived need for imaging. Nurses equally chose flow charts leading to the ED (p=0.41) and equally overruled the protocol (p=0.91). In the intervention group, the mean cost for patients assigned to the GPC was €23 (p<0.01) lower and less patients with an assignment to the GPC were hospitalised (1.0% vs 1.6%, p<0.01). CONCLUSION Nurses used a triage tool more risk averse when it was used to divert patients to primary care as compared with a theoretical assignment to primary care. Outcomes from a simulated setting should not be extrapolated to real patients. TRIAL REGISTRATION NUMBER NCT03793972.
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Affiliation(s)
- Stefan Morreel
- Department of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, Belgium
| | - Veronique Verhoeven
- Department of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, Belgium
| | - Hilde Philips
- Department of Family and Population Health, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen, Belgium
| | - Jasmine Meysman
- Department of Economics, University of Antwerp, Antwerpen, Belgium
| | - Ines Homburg
- Department of Economics, University of Antwerp, Antwerpen, Belgium
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerpen, Belgium
| | - K G Monsieurs
- Emergency Department, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
- ASTARC, University of Antwerp, Antwerpen, Belgium
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Meysman J, Morreel S, Lefevere E, Verhoeven V, De Graeve D, Monsieurs KG, Philips H. Triaging and referring in adjacent general and emergency departments (the TRIAGE-trial): A process evaluation of medical staff experiences in a nurse-led triage system. Int Emerg Nurs 2022; 63:101191. [PMID: 35810679 DOI: 10.1016/j.ienj.2022.101191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/23/2022] [Accepted: 06/04/2022] [Indexed: 11/26/2022]
Abstract
AIMS This process evaluation aims at identifying the facilitators and inhibitors that influenced the successful uptake of a nurse-led triage system streaming low-risk patients from an emergency department (ED) to the general practitioner (GP). DESIGN & METHODS Semi-structured interviews with ED nurses (n = 12), ED doctors (n = 6) from the ED of a Belgian general hospital and GPs (n = 5) affiliated with the adjacent GP cooperative (GPC). The process evaluation ran in parallel with the TRIAGE trial that started in March 2019 and ended 31st of December 2019. The first set of interviews was conducted in June 2019 and the second set in January 2020. Data were analysed based on grounded theory. RESULTS Through a deductive framework, facilitators and inhibitors could be identified on three levels: the organisational, group and individual level. Main inhibitors are the degree of risk aversion of individual nurses, possible language barriers during delivery of the triage advice and the non-adapted ED infrastructure. Training on both the use of the triage protocol and effective delivery of the triage advice, in combination with periodical feedback from the GPC were the most important facilitators. CONCLUSION Based on the process evaluation we can conclude that a consensus exists among stakeholders that the ED Nurses are considered ideally positioned to perform the triage of walk-in patients, although a certain degree of experience is necessary. Although the extended triage protocol and GPC referral increases the complexity and duration of triage and entails a higher workload for the triage nurses, ED nurses found it did lead to a lower (perceived) workload for the ED in general.
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Affiliation(s)
- Jasmine Meysman
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium.
| | - Stefan Morreel
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Eva Lefevere
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Veronique Verhoeven
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Diana De Graeve
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
| | - Koenraad G Monsieurs
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Department of emergency medicine, Antwerp University Hospital, University of Antwerp, Belgium
| | - Hilde Philips
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
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Homburg I, Morreel S, Verhoeven V, Monsieurs KG, Meysman J, Philips H, De Graeve D. Non-compliance with a nurse's advice to visit the primary care provider: an exploratory secondary analysis of the TRIAGE-trial. BMC Health Serv Res 2022; 22:463. [PMID: 35395840 PMCID: PMC8994354 DOI: 10.1186/s12913-022-07904-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background During the cluster randomised TRIAGE-trial, a nurse advised 13% of low-risk patients presenting at an emergency department in Belgium to visit the adjacent general practitioner cooperative. Patients had the right to refuse this advice. This exploratory study examines the characteristics of refusers by uncovering the determinants of non-compliance and its impact on costs, as charged on the patient’s invoice. Methods Bivariate analyses with logistic regressions and T-tests were used to test the differences in patient characteristics, patient status, timing characteristics, and costs between refusers and non-refusers. A chi-square automatic interaction detection analysis was used to find the predictors of non-compliance. Results 23.50% of the patients refused the advice to visit the general practitioner cooperative. This proportion was mainly influenced by the nurse on duty (non-compliance rates per nurse ranging from 2.9% to 52.8%) and the patients’ socio-economic status (receiving increased reimbursement versus not OR 1.37, 95%CI: 0.96 to 1.95). Additionally, non-compliance was associated (at the 0.10 significance level) with being male, not living nearby and certain reasons for encounter. Fewer patients refused when the nurse perceived crowding level as quiet relative to normal, and more patients refused during the evening. The mean cost was significantly higher for patients who refused, which was a result of more extensive examination and higher out-of-pocket expenses at the ED. Conclusions The nurse providing the advice to visit the general practitioner cooperative has a central role in the likelihood of patients’ refusal. Interventions to reduce non-compliance should aim at improving nurse-patient communication. Special attention may be required when managing patients with a lower socio-economic status. The overall mean cost was higher for refusers, illustrating the importance of compliance. Trial registration The trial was registered on registration number NCT03793972 on 04/01/2019.
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Affiliation(s)
- Ines Homburg
- Department of Economics, University of Antwerp, Antwerp, Belgium.
| | - Stefan Morreel
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Koenraad G Monsieurs
- Department ASTARC, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jasmine Meysman
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Hilde Philips
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerp, Belgium
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Haegdorens F, Franck E, Smith P, Bruyneel A, Monsieurs KG, Van Bogaert P. Sufficient personal protective equipment training can reduce COVID-19 related symptoms in healthcare workers: A prospective cohort study. Int J Nurs Stud 2021; 126:104132. [PMID: 34890835 PMCID: PMC8578024 DOI: 10.1016/j.ijnurstu.2021.104132] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The association between inadequate personal protective equipment during the COVID-19 pandemic and an increased risk of SARS-CoV-2 infection in frontline healthcare workers has been proven. However, frontline healthcare workers with an adequate supply of personal protective equipment still showed an increased risk of contracting COVID-19. Research on the use of personal protective equipment could provide insight into handling present and future pandemics. OBJECTIVES This study aims to investigate the impact of the availability, training and correct selection of personal protective equipment on the incidence of SARS-CoV-2 infection or positive suspect cases in healthcare workers during the COVID-19 pandemic in Belgium. DESIGN This was a prospective cohort study involving Belgian healthcare workers: nurses, nursing aides, and midwives working in hospitals, home care services, and residential care services. METHODS Respondents were invited from May to July 2020 (period 1) followed by a second time in October 2020 (period 2) to complete a digital survey on personal protective equipment availability, training, personal protective equipment selection, screening ability, COVID-19 testing and status, and symptoms corresponding with the COVID-19 suspect case definition. The main outcome was a composite of COVID-19 status change (from negative to positive) during the study or a positive suspect case definition in period 2. RESULTS Full data were available for 617 participants. The majority of respondents were nurses (93%) employed in a hospital (83%). In total, 379 respondents provided frontline care for COVID-19 patients (61%) and were questioned on personal protective equipment availability and personal protective equipment selection. Nurses were more likely to select the correct personal protective equipment compared with nursing aides and midwives. Respondents working in residential care settings were least likely to choose personal protective equipment correctly. Of all healthcare workers, 10% tested positive for COVID-19 during the course of the study and a composite outcome was reached in 54% of all respondents. Working experience and sufficient personal protective equipment training showed an inverse relation with the composite outcome. The relationship between personal protective equipment availability and the composite outcome was fully mediated by personal protective equipment training (-0.105 [95% confidence interval -0.211 - -0.020]). CONCLUSIONS Proper training in personal protective equipment usage is critical to reduce the risk of COVID infection in healthcare workers. During a pandemic, rapid dissemination of video guidelines could improve personal protective equipment knowledge in practitioners. Tweetable abstract: Proper training in personal protective equipment usage is critical to reduce the risk of COVID infection in healthcare workers.
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Affiliation(s)
- Filip Haegdorens
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Belgium.
| | - Erik Franck
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Belgium
| | - Pierre Smith
- Institute of Health and Society, Institut de Recherche Santé & Société (IRSS), Université Catholique de Louvain, Belgium
| | - Arnaud Bruyneel
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Koenraad G Monsieurs
- Department of emergency medicine, Antwerp University Hospital, University of Antwerp, Belgium
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Belgium
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Morreel S, Philips H, De Graeve D, Monsieurs KG, Kampen JK, Meysman J, Lefevre E, Verhoeven V. Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial. PLoS One 2021; 16:e0258561. [PMID: 34731198 PMCID: PMC8565772 DOI: 10.1371/journal.pone.0258561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). METHODS Unblinded randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard). RESULTS In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised. CONCLUSIONS ED nurses using a new tool safely diverted 9.5% of the included patients to primary care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03793972.
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Affiliation(s)
- Stefan Morreel
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Hilde Philips
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Koenraad G. Monsieurs
- Department ASTARC, University of Antwerp, Antwerp, Belgium
- Emergency Department, Antwerp University Hospital, Antwerp, Belgium
| | - Jarl K. Kampen
- Department of Epidemiology and Medical Statistics, Antwerp University Hospital, Antwerp, Belgium
| | - Jasmine Meysman
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Eva Lefevre
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
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Böttiger BW, Tan HL, Semeraro F, Monsieurs KG, Perkins GD. The ERC Research NET - Success, current status and perspectives of the international network for cardiac arrest, resuscitation and post-resuscitation care research. Resuscitation 2021; 165:127-129. [PMID: 34166744 DOI: 10.1016/j.resuscitation.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital of Cologne, Cologne, Germany.
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- Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital of Cologne, Cologne, Germany
| | - Hanno L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick University, Gibbet Hill, Coventry, UK
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Greif R, Lockey A, Breckwoldt J, Carmona F, Conaghan P, Kuzovlev A, Pflanzl-Knizacek L, Sari F, Shammet S, Scapigliati A, Turner N, Yeung J, Monsieurs KG. [Education for resuscitation]. Notf Rett Med 2021; 24:750-772. [PMID: 34093075 PMCID: PMC8170459 DOI: 10.1007/s10049-021-00890-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/22/2022]
Abstract
Diese Leitlinien des European Resuscitation Council basieren auf dem internationalen wissenschaftlichen Konsens 2020 zur kardiopulmonalen Reanimation mit Behandlungsempfehlungen (International Liaison Committee on Resuscitation 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations [ILCOR] 2020 CoSTR). Dieser Abschnitt bietet Bürgern und Angehörigen der Gesundheitsberufe Anleitungen zum Lehren und Lernen der Kenntnisse, der Fertigkeiten und der Einstellungen zur Reanimation mit dem Ziel, das Überleben von Patienten nach Kreislaufstillstand zu verbessern.
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Affiliation(s)
- Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Schweiz.,School of Medicine, Sigmund Freud University Vienna, Wien, Österreich
| | - Andrew Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, Großbritannien
| | - Jan Breckwoldt
- Institute of Anesthesiology, University Hospital Zurich, Zürich, Schweiz
| | | | - Patricia Conaghan
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, Großbritannien
| | - Artem Kuzovlev
- Negovsky Research Institute of General Reanimatology of the Federal research and clinical center of intensive care medicine and Rehabilitology, Moskau, Russland
| | - Lucas Pflanzl-Knizacek
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Ferenc Sari
- Emergency Department, Skellefteå Hospital, Skellefteå, Schweden
| | | | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rom, Italien
| | - Nigel Turner
- Department of Pediatric Anesthesia, Division of Vital Functions, Wilhelmina Children's Hospital at the University Medical Center, Utrecht, Niederlande
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, Großbritannien
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgien
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdóttir H, Perkins GD. [Basic life support]. Notf Rett Med 2021; 24:386-405. [PMID: 34093079 PMCID: PMC8170637 DOI: 10.1007/s10049-021-00885-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), cardiopulmonary resuscitation (CPR) quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M. Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norwegen
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italien
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Mailand, Italien
- Department of Pathophysiology and Transplantation, University of Milan, Mailand, Italien
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finnland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moskau, Russland
| | - Koenraad G. Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerpen, Belgien
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nikosia, Zypern
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- West Midlands Ambulance Service, DY5 1LX Brierly Hill, West Midlands Großbritannien
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, Großbritannien
| | - Hildigunnur Svavarsdóttir
- Akureyri Hospital, Akureyri, Island
- Institute of Health Science Research, University of Akureyri, Akureyri, Island
| | - Gavin D. Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, CV4 7AL Coventry, Großbritannien
- University Hospitals Birmingham, B9 5SS Birmingham, Großbritannien
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14
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Olasveengen TM, Semeraro F, Ristagno G, Castren M, Handley A, Kuzovlev A, Monsieurs KG, Raffay V, Smyth M, Soar J, Svavarsdottir H, Perkins GD. European Resuscitation Council Guidelines 2021: Basic Life Support. Resuscitation 2021; 161:98-114. [PMID: 33773835 DOI: 10.1016/j.resuscitation.2021.02.009] [Citation(s) in RCA: 219] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The European Resuscitation Council has produced these basic life support guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include cardiac arrest recognition, alerting emergency services, chest compressions, rescue breaths, automated external defibrillation (AED), CPR quality measurement, new technologies, safety, and foreign body airway obstruction.
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Affiliation(s)
- Theresa M Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway.
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ristagno
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Italy
| | - Maaret Castren
- Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | | | - Artem Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, V.A. Negovsky Research Institute of General Reanimatology, Moscow, Russia
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - Violetta Raffay
- Department of Medicine, School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Michael Smyth
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; West Midlands Ambulance Service and Midlands Air Ambulance, Brierly Hill, West Midlands DY5 1LX, United Kingdom
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
| | - Hildigunnur Svavarsdottir
- Akureyri Hospital, Akureyri, Iceland; Institute of Health Science Research, University of Akureyri, Akureyri, Iceland
| | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom; University Hospitals Birmingham, Birmingham B9 5SS, United Kingdom
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15
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Greif R, Lockey A, Breckwoldt J, Carmona F, Conaghan P, Kuzovlev A, Pflanzl-Knizacek L, Sari F, Shammet S, Scapigliati A, Turner N, Yeung J, Monsieurs KG. European Resuscitation Council Guidelines 2021: Education for resuscitation. Resuscitation 2021; 161:388-407. [PMID: 33773831 DOI: 10.1016/j.resuscitation.2021.02.016] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
These European Resuscitation Council education guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidance to citizens and healthcare professionals with regard to teaching and learning the knowledge, skills and attitudes of resuscitation with the ultimate aim of improving patient survival after cardiac arrest.
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Affiliation(s)
- Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria.
| | - Andrew Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, UK
| | - Jan Breckwoldt
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Patricia Conaghan
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Artem Kuzovlev
- Negovsky Research Institute of General Reanimatology of the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Lucas Pflanzl-Knizacek
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ferenc Sari
- Emergency Department, Skellefteå Hospital, Sweden
| | | | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Nigel Turner
- Department of Pediatric Anesthesia, Division of Vital Functions, Wilhelmina Children's Hospital at the University Medical Center, Utrecht, The Netherlands
| | - Joyce Yeung
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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Kuzovlev A, Monsieurs KG, Gilfoyle E, Finn J, Greif R. The effect of team and leadership training of advanced life support providers on patient outcomes: A systematic review. Resuscitation 2021; 160:126-139. [PMID: 33556422 DOI: 10.1016/j.resuscitation.2021.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/03/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
AIM To conduct a systematic review evaluating improvement in team and leadership performance and resuscitation outcomes after such a training of healthcare providers during advanced life support (ALS) courses. METHODS This systematic review asked the question of whether students taking structured and standardised ALS courses in an educational setting which include specific leadership or team training, compared to no such specific training in these courses, improves patient survival, skill performance in actual resuscitations, skill performance at 3-15 months (patient tasks, teamwork, leadership), skill performance at course conclusion (patient tasks, teamwork, leadership), or cognitive knowledge PubMed, Embase and the Cochrane database were searched until April 2020. Screening of articles, analysis of risk of bias, outcomes and quality assessment were performed according to the Grading of Recommendations Assessment, Development and Evaluation methodology. Only studies with abstracts in English were included. RESULTS 14 non-randomised studies and 17 randomised controlled trials, both in adults and children, and seven studies involving patients were included in this systematic review. No randomised controlled trials but three observational studies of team and leadership training showed improvement in the critical outcome of "patient survival". However, they suffered from risk of bias (indirectness and imprecision). The included studies reported many different methods to teach leadership skills and team behaviour. CONCLUSION This systematic review found very low certainty evidence that team and leadership training as part of ALS courses improved patient outcome. This supports the inclusion of team and leadership training in ALS courses for healthcare providers.
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Affiliation(s)
- A Kuzovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia.
| | - K G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Belgium
| | - E Gilfoyle
- Department of Paediatrics, University of Toronto, Canada
| | - J Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - R Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Druwé P, Monsieurs KG, Gagg J, Nakahara S, Cocchi MN, Élő G, van Schuppen H, Alpert EA, Truhlář A, Huybrechts SA, Mpotos N, Paal P, BjØrshol C, Xanthos T, Joly LM, Roessler M, Deasy C, Svavarsdóttir H, Nurmi J, Owczuk R, Salmeron PP, Cimpoesu D, Fuenzalida PA, Raffay V, Steen J, Decruyenaere J, De Paepe P, Piers R, Benoit DD. Impact of perceived inappropiate cardiopulmonary resuscitation on emergency clinicians' intention to leave the job: Results from a cross-sectional survey in 288 centres across 24 countries. Resuscitation 2020; 158:41-48. [PMID: 33227397 DOI: 10.1016/j.resuscitation.2020.10.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/22/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cardiopulmonary resuscitation (CPR) in patients with a poor prognosis increases the risk of perception of inappropriate care leading to moral distress in clinicians. We evaluated whether perception of inappropriate CPR is associated with intention to leave the job among emergency clinicians. METHODS A cross-sectional multi-centre survey was conducted in 24 countries. Factors associated with intention to leave the job were analysed by conditional logistic regression models. Results are expressed as odds ratios with 95% confidence intervals. RESULTS Of 5099 surveyed emergency clinicians, 1836 (36.0%) were physicians, 1313 (25.7%) nurses, 1950 (38.2%) emergency medical technicians. Intention to leave the job was expressed by 1721 (33.8%) clinicians, 3403 (66.7%) often wondered about the appropriateness of a resuscitation attempt, 2955 (58.0%) reported moral distress caused by inappropriate CPR. After adjustment for other covariates, the risk of intention to leave the job was higher in clinicians often wondering about the appropriateness of a resuscitation attempt (1.43 [1.23-1.67]), experiencing associated moral distress (1.44 [1.24-1.66]) and who were between 30-44 years old (1.53 [1.21-1.92] compared to <30 years). The risk was lower when the clinician felt valued by the team (0.53 [0.42-0.66]), when the team leader acknowledged the efforts delivered by the team (0.61 [0.49-0.75]) and in teams that took time for debriefing (0.70 [0.60-0.80]). CONCLUSION Resuscitation attempts perceived as inappropriate by clinicians, and the accompanying moral distress, were associated with an increased likelihood of intention to leave the job. Interprofessional collaboration, teamwork, and regular interdisciplinary debriefing were associated with a lower risk of intention to leave the job. ClinicalTrials.gov; No.: NCT02356029.
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Affiliation(s)
- Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - James Gagg
- Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | | | - Michael N Cocchi
- Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, USA
| | - Gábor Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Hans van Schuppen
- Amsterdam UMC, University of Amsterdam, Department of Anesthesiology, Amsterdam, The Netherlands
| | | | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic
| | | | - Nicolas Mpotos
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Hospitallers Brothers Hospital, Medical University Salzburg, Austria
| | - Conrad BjØrshol
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Norway
| | - Theodoros Xanthos
- European University, Nicosia, Cyprus; Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Luc-Marie Joly
- Department of Emergency Medicine, Rouen University Hospital, Rouen, France
| | - Markus Roessler
- Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
| | | | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Radoslaw Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Diana Cimpoesu
- University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania
| | | | | | - Johan Steen
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Decruyenaere
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Peter De Paepe
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
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Schnaubelt S, Monsieurs KG, Semeraro F, Schlieber J, Cheng A, Bigham BL, Garg R, Finn JC, Greif R. Clinical outcomes from out-of-hospital cardiac arrest in low-resource settings - A scoping review. Resuscitation 2020; 156:137-145. [PMID: 32920113 DOI: 10.1016/j.resuscitation.2020.08.126] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
AIM OF THE SCOPING REVIEW Scientific recommendations on resuscitation are typically formulated from the perspective of an ideal resource environment, with little consideration of applicability in lower-income countries. We aimed to determine clinical outcomes from out-of-hospital cardiac arrest (OHCA) in low-resource countries, to identify shortcomings related to resuscitation in these areas and possible solutions, and to suggest future research priorities. DATA SOURCES This scoping review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR), and was performed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. We identified low-resource countries as countries with a low- or middle gross national income per capita (World Bank data). We performed a literature search on outcomes after OHCA in these countries, and we extracted data on the outcome. We applied descriptive statistics and conducted a post-hoc correlation analysis of cohort size and ROSC rates. RESULTS We defined 24 eligible studies originating from middle-income countries, but none from low-income regions, suggesting a reporting bias. The number of reported patients in these studies ranged from 54 to 3214. Utstein-style reporting was rarely used. Return of spontaneous circulation varied from 0% to 62%. Fifteen studies reported on survival to hospital discharge (between 1.0 and 16.7%) or favourable neurological outcome (between 1.0 and 9.3%). An inverse correlation was found for study cohort size and the rate of return of spontaneous circulation (ρ = -0.48, p = 0.034). CONCLUSION Studies of OHCA outcomes in low-resource countries are heterogeneous and may be compromised by reporting bias. Minimum cardiopulmonary resuscitation standards for low-resource settings should be developed collaboratively involving local experts, respecting culture and context while balancing competing health priorities.
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Affiliation(s)
- S Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Austria.
| | - K G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital Bologna, Italy
| | - J Schlieber
- Department of Anaesthesia and Intensive Care, Allgemeine Unfallversicherungsanstalt, Trauma Centre Salzburg, Salzburg, Austria
| | - A Cheng
- Departments of Paediatrics and Emergency Medicine, University of Calgary, Calgary, Canada
| | - B L Bigham
- Department of Medicine, Stanford University, CA, USA
| | - R Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr Braich, All India Institute of Medical Sciences, New Delhi, India
| | - J C Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - R Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2020; 142:S222-S283. [PMID: 33084395 DOI: 10.1161/cir.0000000000000896] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Greif R, Bhanji F, Bigham BL, Bray J, Breckwoldt J, Cheng A, Duff JP, Gilfoyle E, Hsieh MJ, Iwami T, Lauridsen KG, Lockey AS, Ma MHM, Monsieurs KG, Okamoto D, Pellegrino JL, Yeung J, Finn JC, Baldi E, Beck S, Beckers SK, Blewer AL, Boulton A, Cheng-Heng L, Yang CW, Coppola A, Dainty KN, Damjanovic D, Djärv T, Donoghue A, Georgiou M, Gunson I, Krob JL, Kuzovlev A, Ko YC, Leary M, Lin Y, Mancini ME, Matsuyama T, Navarro K, Nehme Z, Orkin AM, Pellis T, Pflanzl-Knizacek L, Pisapia L, Saviani M, Sawyer T, Scapigliati A, Schnaubelt S, Scholefield B, Semeraro F, Shammet S, Smyth MA, Ward A, Zace D. Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2020; 156:A188-A239. [PMID: 33098918 DOI: 10.1016/j.resuscitation.2020.09.014] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For this 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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21
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Haegdorens F, Monsieurs KG, De Meester K, Van Bogaert P. The optimal threshold for prompt clinical review: An external validation study of the national early warning score. J Clin Nurs 2020; 29:4594-4603. [PMID: 32920891 DOI: 10.1111/jocn.15493] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/07/2020] [Accepted: 08/29/2020] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES The aim of this study was to determine the optimal threshold for national early warning score in clinical practice. BACKGROUND The national early warning score is an aggregate early warning score aiming to predict patient mortality. Studies validating national early warning score did not use standardised patient outcomes or did not always include clinical workload in their results. Since all patients with a positive national early warning score require a clinical workup, it is crucial to determine the optimal threshold to limit false-positive alerts. DESIGN An external validation study using retrospectively collected data of patient admissions in six Belgian hospitals. METHODS We adhered to the STARD guideline for reporting. Two sample groups were selected: the cross-sectional sample (admitted patients, 1 day every 4 months) and the serious adverse event sample (all patients with unexpected death, cardiac arrest and unplanned admission to the intensive care unit). The maximum registered national early warning score value was collected in both groups. Predictive values were used as estimates for clinical workload. RESULTS We collected 1,523 in the cross-sectional sample and 390 patients in the serious adverse event sample. A national early warning score ≥5 had a predictive value of 6.8% and a negative predictive value of 99.5% to predict unexpected death, cardiac arrest with cardiopulmonary resuscitation or unplanned admission to intensive care (AUROC 0.841). The performance of national early warning score differed between outcome measures. Considering the predictive value, the optimal threshold for national early warning score is ≥5. CONCLUSIONS We validated national early warning score to be applied in general hospital wards and confirmed the optimal threshold (≥5). RELEVANCE TO CLINICAL PRACTICE When a patient has a national early warning score <5, we may assume that in the next 24 hr this patient is less likely to die unexpectedly, receive cardiopulmonary resuscitation or be transferred to the ICU. Because of the significant number of false positives when national early warning score is ≥5, hospitals should create workable guidelines for clinical practice.
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Affiliation(s)
- Filip Haegdorens
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Wilrijk, Belgium
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Koen De Meester
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Wilrijk, Belgium
| | - Peter Van Bogaert
- Department of Nursing and Midwifery Sciences, Centre for Research and Innovation in Care (CRIC), University of Antwerp, Wilrijk, Belgium
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22
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Semeraro F, Ristagno G, Greif R, Lockey A, Monsieurs KG, Nolan JP, Olasveengen TM, Perkins GD, Scapigliati A, Böttiger BW. Renewed KIDS SAVE LIVES campaign to further increase awareness and fight sudden cardiac death in the era of COVID-19. Resuscitation 2020; 153:183-184. [PMID: 32574653 PMCID: PMC7305918 DOI: 10.1016/j.resuscitation.2020.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy
| | - Giuseppe Ristagno
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Robert Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Andrew Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, United Kingdom
| | | | - Jerry P Nolan
- Warwick Clinical Trials Unit, University of Warwick and Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom
| | | | - Gavin D Perkins
- Warwick Clinical Trials Unit and University Hospitals Birmingham NHS Foundation Trust, University of Warwick, Coventry, United Kingdom
| | - Andrea Scapigliati
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Bernd W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
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Nolan JP, Monsieurs KG, Bossaert L, Böttiger BW, Greif R, Lott C, Madar J, Olasveengen TM, Roehr CC, Semeraro F, Soar J, Van de Voorde P, Zideman DA, Perkins GD. European Resuscitation Council COVID-19 guidelines executive summary. Resuscitation 2020; 153:45-55. [PMID: 32525022 PMCID: PMC7276132 DOI: 10.1016/j.resuscitation.2020.06.001] [Citation(s) in RCA: 178] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has had a substantial impact on the incidence of cardiac arrest and survival. The challenge is to find the correct balance between the risk to the rescuer when undertaking cardiopulmonary resuscitation (CPR) on a person with possible COVID-19 and the risk to that person if CPR is delayed. These guidelines focus specifically on patients with suspected or confirmed COVID-19. The guidelines include the delivery of basic and advanced life support in adults and children and recommendations for delivering training during the pandemic. Where uncertainty exists treatment should be informed by a dynamic risk assessment which may consider current COVID-19 prevalence, the person’s presentation (e.g. history of COVID-19 contact, COVID-19 symptoms), likelihood that treatment will be effective, availability of personal protective equipment (PPE) and personal risks for those providing treatment. These guidelines will be subject to evolving knowledge and experience of COVID-19. As countries are at different stages of the pandemic, there may some international variation in practice.
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Affiliation(s)
- J P Nolan
- Resuscitation Medicine, University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, BA1 3NG UK.
| | - K G Monsieurs
- Emergency Department, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - L Bossaert
- University of Antwerp, Antwerp, Belgium; European Resuscitation Council (ERC), Niel, Belgium
| | - B W Böttiger
- Anaesthesiology and Intensive Care Medicine, Director of Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - R Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, Inselspital, 3010 Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - C Lott
- Department of Anaesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - J Madar
- University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH UK; Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - T M Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - C C Roehr
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), Medical Sciences Division, University of Oxford. Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust University of Oxford Richard Doll Building, Old Road Campus, Headington, Oxford OX3 7LF UK
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy
| | - J Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - P Van de Voorde
- Emergency Medicine - Clinical Head, Ghent University Hospital and University of Ghent, C. Heymanslaan 10, 9000 Ghent, Belgium; Emergency Dispatch Centre, 112 West/East-Flanders, Federal Dept Health, Belgium
| | - D A Zideman
- Anaesthesia and Pre-Hospital Emergency Medicine, Thames Valley Air Ambulance, Stokenchurch House, Stokenchurch, HP14 3SX, UK
| | - G D Perkins
- Critical Care Medicine, University of Warwick, Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, Coventry, CV4 7AL, UK
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Scquizzato T, Burkart R, Greif R, Monsieurs KG, Ristagno G, Scapigliati A, Semeraro F. Mobile phone systems to alert citizens as first responders and to locate automated external defibrillators: A European survey. Resuscitation 2020; 151:39-42. [DOI: 10.1016/j.resuscitation.2020.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
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Böttiger BW, Lockey A, Georgiou M, Greif R, Monsieurs KG, Mpotos N, Nikolaou N, Nolan J, Perkins G, Semeraro F, Wingen S. KIDS SAVE LIVES: ERC Position statement on schoolteachers' education and qualification in resuscitation. Resuscitation 2020; 151:87-90. [PMID: 32339597 PMCID: PMC7194866 DOI: 10.1016/j.resuscitation.2020.04.021] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 12/11/2022]
Affiliation(s)
- B W Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
| | - A Lockey
- Emergency Department, Calderdale Royal Hospital, Halifax, United Kingdom
| | - M Georgiou
- American Medical Center, Nicosia, Cyprus
| | - R Greif
- Department of Anesthesiology and Pain Therapy, Bern University Hospital, University of Bern, Bern, Switzerland; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - K G Monsieurs
- Emergency Department, Antwerp University Hospital, Edegem, Belgium
| | - N Mpotos
- Faculty of Medicine and Health Sciences, Ghent University and Department of Emergency Medicine, St. Lucas General Hospital, Ghent, Belgium
| | - N Nikolaou
- Department of Cardiology and Cardiac Intensive Care, Konstantopouleio General Hospital, Athens, Greece
| | - J Nolan
- Warwick Clinical Trials Unit, University of Warwick and Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, United Kingdom
| | - G Perkins
- Warwick Clinical Trials Unit and University Hospitals Birmingham NHS Foundation Trust, University of Warwick, Coventry, United Kingdom
| | - F Semeraro
- Department of Anaesthesia, Intensive Care and EMS, Maggiore Hospital, Bologna, Italy
| | - S Wingen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany
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Druwé P, Benoit DD, Monsieurs KG, Gagg J, Nakahara S, Alpert EA, van Schuppen H, Élő G, Huybrechts SA, Mpotos N, Joly LM, Xanthos T, Roessler M, Paal P, Cocchi MN, Bjørshol C, Nurmi J, Salmeron PP, Owczuk R, Svavarsdóttir H, Cimpoesu D, Raffay V, Pachys G, De Paepe P, Piers R. Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians. J Am Geriatr Soc 2019; 68:39-45. [PMID: 31840239 DOI: 10.1111/jgs.16270] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 08/29/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out-of-hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN Subanalysis of an international multicenter cross-sectional survey (REAPPROPRIATE). SETTING Out-of-hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the "appropriate" subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the "uncertain" subgroup, and 2 of 107 (1.9%) in the "inappropriate" subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non-shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non-shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39-45, 2019.
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Affiliation(s)
- Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | | | - James Gagg
- Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | | | | | - Hans van Schuppen
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Gábor Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Sofie A Huybrechts
- Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Nicolas Mpotos
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Luc-Marie Joly
- Department of Emergency Medicine, Rouen University Hospital, Rouen, France
| | - Theodoros Xanthos
- European University, Nicosia, Cyprus, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Markus Roessler
- Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Peter Paal
- Department of Anesthesiology and Critical Care Medicine, Hospitallers Brothers Hospital, Medical University Salzburg, Salzburg, Austria
| | - Michael N Cocchi
- Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Conrad Bjørshol
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Radoslaw Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Diana Cimpoesu
- University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania
| | | | - Gal Pachys
- Emergency Department, Sourasky Medical Center, Tel Aviv, Israel
| | - Peter De Paepe
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Soar J, Maconochie I, Wyckoff MH, Olasveengen TM, Singletary EM, Greif R, Aickin R, Bhanji F, Donnino MW, Mancini ME, Wyllie JP, Zideman D, Andersen LW, Atkins DL, Aziz K, Bendall J, Berg KM, Berry DC, Bigham BL, Bingham R, Couto TB, Böttiger BW, Borra V, Bray JE, Breckwoldt J, Brooks SC, Buick J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Couper K, Dainty KN, Dawson JA, de Almeida MF, de Caen AR, Deakin CD, Drennan IR, Duff JP, Epstein JL, Escalante R, Gazmuri RJ, Gilfoyle E, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Holmberg MJ, Hood N, Hosono S, Hsieh MJ, Isayama T, Iwami T, Jensen JL, Kapadia V, Kim HS, Kleinman ME, Kudenchuk PJ, Lang E, Lavonas E, Liley H, Lim SH, Lockey A, Lofgren B, Ma MHM, Markenson D, Meaney PA, Meyran D, Mildenhall L, Monsieurs KG, Montgomery W, Morley PT, Morrison LJ, Nadkarni VM, Nation K, Neumar RW, Ng KC, Nicholson T, Nikolaou N, Nishiyama C, Nuthall G, Ohshimo S, Okamoto D, O’Neil B, Yong-Kwang Ong G, Paiva EF, Parr M, Pellegrino JL, Perkins GD, Perlman J, Rabi Y, Reis A, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Skrifvars MB, Smyth MA, Stanton D, Swain J, Szyld E, Tijssen J, Travers A, Trevisanuto D, Vaillancourt C, Van de Voorde P, Velaphi S, Wang TL, Weiner G, Welsford M, Woodin JA, Yeung J, Nolan JP, Fran Hazinski M. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2019; 140:e826-e880. [DOI: 10.1161/cir.0000000000000734] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
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Haegdorens F, Van Bogaert P, De Meester K, Monsieurs KG. The impact of nurse staffing levels and nurse's education on patient mortality in medical and surgical wards: an observational multicentre study. BMC Health Serv Res 2019; 19:864. [PMID: 31752859 PMCID: PMC6868706 DOI: 10.1186/s12913-019-4688-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Growing evidence indicates that improved nurse staffing in acute hospitals is associated with lower hospital mortality. Current research is limited to studies using hospital level data or without proper adjustment for confounders which makes the translation to practice difficult. METHOD In this observational study we analysed retrospectively the control group of a stepped wedge randomised controlled trial concerning 14 medical and 14 surgical wards in seven Belgian hospitals. All patients admitted to these wards during the control period were included in this study. Pregnant patients or children below 17 years of age were excluded. In all patients, we collected age, crude ward mortality, unexpected death, cardiac arrest with Cardiopulmonary Resuscitation (CPR), and unplanned admission to the Intensive Care Unit (ICU). A composite mortality measure was constructed including unexpected death and death up to 72 h after cardiac arrest with CPR or unplanned ICU admission. Every 4 months we obtained, from 30 consecutive patient admissions across all wards, the Charlson comorbidity index. The amount of nursing hours per patient days (NHPPD) were calculated every day for 15 days, once every 4 months. Data were aggregated to the ward level resulting in 68 estimates across wards and time. Linear mixed models were used since they are most appropriate in case of clustered and repeated measures data. RESULTS The unexpected death rate was 1.80 per 1000 patients. Up to 0.76 per 1000 patients died after CPR and 0.62 per 1000 patients died after unplanned admission to the ICU. The mean composite mortality was 3.18 per 1000 patients. The mean NHPPD and proportion of nurse Bachelor hours were respectively 2.48 and 0.59. We found a negative association between the nursing hours per patient day and the composite mortality rate adjusted for possible confounders (B = - 2.771, p = 0.002). The proportion of nurse Bachelor hours was negatively correlated with the composite mortality rate in the same analysis (B = - 8.845, p = 0.023). Using the regression equation, we calculated theoretically optimal NHPPDs. CONCLUSIONS This study confirms the association between higher nurse staffing levels and lower patient mortality controlled for relevant confounders.
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Affiliation(s)
- Filip Haegdorens
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Koen De Meester
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Koenraad G Monsieurs
- Department of emergency medicine, Antwerp University Hospital, University of Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
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De Smedt L, Depuydt C, Vekeman E, De Paepe P, Monsieurs KG, Valcke M, Mpotos N. Awareness and willingness to perform CPR: a survey amongst Flemish schoolchildren, teachers and principals. Acta Clin Belg 2019; 74:297-316. [PMID: 29874976 DOI: 10.1080/17843286.2018.1482087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Training children in cardiopulmonary resuscitation (CPR) is one of the strategies to increase bystander CPR in society. Reinforcing knowledge and awareness and increasing willingness to perform bystander CPR contributes to a better outcome after cardiac arrest. We questioned schoolchildren, teachers and principals about their awareness of the importance of CPR and about their willingness to perform CPR. METHODS During a four-month period, Flemish schoolchildren aged 10-18 years, teachers and principals were invited to complete a survey consisting of three parts: (1) demographics, (2) CPR (training) experience and (3) attitude towards CPR teaching and training. RESULT In total, 390 schoolchildren, 439 teachers and 100 principals completed the survey. Previous CPR training was reported by 33% of the schoolchildren (in 82% as part of the curriculum) and by 81% teachers and 82% principals. Willingness to participate in CPR training was 77% in schoolchildren, 79% in teachers and 86% in principals with 88% of the principals convinced that schoolchildren should learn how to perform CPR. Willingness to perform CPR in a real-life situation was 68% in schoolchildren, 84% in teachers and 92% in principals. CONCLUSION Schoolchildren are well aware of the importance of CPR and are willing to acquire the related knowledge and skills. Noteworthy is the larger awareness among principals and teachers, establishing a strong base for increasing implementation of CPR training in schools. However, a majority of children indicated a lack of training opportunities, highlighting the need for a stronger implementation.
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Affiliation(s)
- Lieven De Smedt
- Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
| | | | - Eva Vekeman
- Department of Educational Studies, Ghent University , Ghent, Belgium
| | - Peter De Paepe
- Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
- Emergency Department, Antwerp University Hospital , Edegem, Belgium
| | - Koenraad G. Monsieurs
- Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
- Emergency Department, Antwerp University Hospital , Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp , Wilrijk, Belgium
| | - Martin Valcke
- Department of Educational Studies, Ghent University , Ghent, Belgium
| | - Nicolas Mpotos
- Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
- Emergency Department, St. Lucas General Hospital , Ghent, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp , Wilrijk, Belgium
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Haegdorens F, Monsieurs KG, De Meester K, Van Bogaert P. An intervention including the national early warning score improves patient monitoring practice and reduces mortality: A cluster randomized controlled trial. J Adv Nurs 2019; 75:1996-2005. [DOI: 10.1111/jan.14034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Filip Haegdorens
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences University of Antwerp Wilrijk Belgium
| | - Koenraad G. Monsieurs
- Department of Emergency Medicine Antwerp University Hospital, University of Antwerp Edegem Belgium
| | - Koen De Meester
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences University of Antwerp Wilrijk Belgium
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care (CRIC), Department of Nursing and Midwifery Sciences University of Antwerp Wilrijk Belgium
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Soar J, Perkins GD, Monsieurs KG, Nolan JP. Author response: A critique of the recent 2018 ERC CPR guidelines. Resuscitation 2019; 139:368. [DOI: 10.1016/j.resuscitation.2019.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 04/02/2019] [Indexed: 11/16/2022]
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Lemoyne SE, Herbots HH, De Blick D, Remmen R, Monsieurs KG, Van Bogaert P. Appropriateness of transferring nursing home residents to emergency departments: a systematic review. BMC Geriatr 2019; 19:17. [PMID: 30665362 PMCID: PMC6341611 DOI: 10.1186/s12877-019-1028-z] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 01/04/2019] [Indexed: 01/08/2023] Open
Abstract
Background Elderly living in a Nursing Home (NH) are frequently transferred to an Emergency Department when they need acute medical care. A proportion of these transfers may be considered inappropriate and may be avoidable. Methods Systematic review. Literature search performed in September 2018 using PubMed, Web of Science, the Cochrane Library and the Cumulative Index to Nursing and Allied Health Literature database. Titles and abstracts were screened against inclusion and exclusion criteria. Full-texts of the selected abstracts were read and checked for relevance. All years and all languages were included provided there was an English, French, Dutch or German abstract. Results Seventy-seven articles were included in the systematic review: 1 randomised control trial (RCT), 6 narrative reviews, 9 systematic reviews, 7 experimental studies, 10 qualitative studies and 44 observational studies. Of all acute transfers of NH residents to an ED, 4 to 55% were classified as inappropriate. The most common reasons for transfer were trauma after falling, altered mental status and infection. Transfers were associated with a high risk of complications and mortality, especially during out-of-hours. Advance directives (ADs) were usually not available and relatives often urge NH staff to transfer patients to an ED. The lack of availability of GPs was a barrier to organise acute care in the NH in order to prevent admission to the hospital. Conclusions The definition of appropriateness is not uniform across studies and needs further investigation. To avoid inappropriate transfer to EDs, we recommend to respect the patient’s autonomy, to provide sufficient nursing staff and to invest in their education, to increase the role of GPs in the care of NH residents both in standard and in acute situations, and to promote interprofessional communication and collaboration between GPs, NH staff and EDs. Electronic supplementary material The online version of this article (10.1186/s12877-019-1028-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabine E Lemoyne
- Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Hanne H Herbots
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Dennis De Blick
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Koenraad G Monsieurs
- Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Peter Van Bogaert
- Center for Research and Innovation in Care, Universiteitsplein 1, 2610, Wilrijk, Belgium
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Soar J, Perkins GD, Maconochie I, Böttiger BW, Deakin CD, Sandroni C, Olasveengen TM, Wyllie J, Greif R, Lockey A, Semeraro F, Van de Voorde P, Lott C, Bossaert L, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation: 2018 Update – Antiarrhythmic drugs for cardiac arrest. Resuscitation 2019; 134:99-103. [DOI: 10.1016/j.resuscitation.2018.11.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/23/2018] [Indexed: 01/02/2023]
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Druwé P, Monsieurs KG, Piers R, Gagg J, Nakahara S, Alpert EA, van Schuppen H, Élő G, Truhlář A, Huybrechts SA, Mpotos N, Joly LM, Xanthos T, Roessler M, Paal P, Cocchi MN, BjØrshol C, Pauliková M, Nurmi J, Salmeron PP, Owczuk R, Svavarsdóttir H, Deasy C, Cimpoesu D, Ioannides M, Fuenzalida PA, Kurland L, Raffay V, Pachys G, Gadeyne B, Steen J, Vansteelandt S, De Paepe P, Benoit DD. Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services: The REAPPROPRIATE international, multi-centre, cross sectional survey. Resuscitation 2018; 132:112-119. [PMID: 30218746 DOI: 10.1016/j.resuscitation.2018.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/16/2018] [Accepted: 09/09/2018] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. METHODS A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models. RESULTS Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P < .0001), a non-witnessed arrest (2.68 [1.89-3.79]; P < .0001), in older patients (2.94 [2.18-3.96]; P < .0001, for patients >79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P < .0001). In accordance, non-shockable and non-witnessed arrests were both associated with lower survival to hospital discharge (0.33 [0.26-0.41]; P < 0.0001 and 0.25 [0.15-0.41]; P < 0.0001, respectively), as were older patient age (0.25 [0.14-0.44]; P < 0.0001 for patients >79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P < 0.0001). CONCLUSIONS The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.
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Affiliation(s)
- Patrick Druwé
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
| | | | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - James Gagg
- Department of Emergency Medicine, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, United Kingdom
| | | | | | - Hans van Schuppen
- Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gábor Élő
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Kralove Region and University Hospital Hradec Kralove, Czech Republic
| | - Sofie A Huybrechts
- Department of Emergency Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Nicolas Mpotos
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Luc-Marie Joly
- Department of Emergency Medicine, Rouen University Hospital, Rouen, France
| | - Theodoros Xanthos
- European University, Nicosia, Cyprus, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Markus Roessler
- Department of Anaesthesiology, University Medical Centre Göttingen, Göttingen, Germany
| | - Peter Paal
- Department of Anesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Michael N Cocchi
- Harvard Medical School, Department of Emergency Medicine and Department of Anesthesia, Critical Care and Pain Medicine, Division of Critical Care, Beth Israel Deaconess Medical Center, USA
| | - Conrad BjØrshol
- Department of Anesthesiology and Intensive Care, Stavanger University Hospital, The Regional Centre for Emergency Medical Research and Development (RAKOS), Department of Clinical Medicine, University of Bergen, Norway
| | - Monika Pauliková
- Department of Anesthesiology and Intensive Care, East Slovak Institute of Oncology, Košice, Slovakia
| | - Jouni Nurmi
- Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | | | - Radoslaw Owczuk
- Department of Anaesthesiology and Intensive Therapy, Medical University of Gdansk, Gdansk, Poland
| | | | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Republic of Ireland
| | - Diana Cimpoesu
- University of Medicine and Pharmacy Gr.T. Popa and Emergency County Hospital Sf. Spiridon, Iasi, Romania
| | | | | | - Lisa Kurland
- Department of Medical Sciences, Örebro University and Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden
| | - Violetta Raffay
- Municipal Institute for Emergency Medicine, Novi Sad, Serbia
| | - Gal Pachys
- Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Bram Gadeyne
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Johan Steen
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Stijn Vansteelandt
- Department of Applied Mathematics, Computer Science and Statistics, Faculty of Sciences, Ghent University, Ghent, Belgium; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Peter De Paepe
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
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Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Böttiger BW, Brooks A, Castrén M, Ong ME, Hazinski MF, Koster RW, Lilja G, Long J, Monsieurs KG, Morley PT, Morrison L, Nichol G, Oriolo V, Saposnik G, Smyth M, Spearpoint K, Williams B, Perkins GD. COSCA (Core Outcome Set for Cardiac Arrest) in Adults: An Advisory Statement From the International Liaison Committee on Resuscitation. Circulation 2018; 137:e783-e801. [PMID: 29700122 DOI: 10.1161/cir.0000000000000562] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac arrest effectiveness trials have traditionally reported outcomes that focus on survival. A lack of consistency in outcome reporting between trials limits the opportunities to pool results for meta-analysis. The COSCA initiative (Core Outcome Set for Cardiac Arrest), a partnership between patients, their partners, clinicians, research scientists, and the International Liaison Committee on Resuscitation, sought to develop a consensus core outcome set for cardiac arrest for effectiveness trials. Core outcome sets are primarily intended for large, randomized clinical effectiveness trials (sometimes referred to as pragmatic trials or phase III/IV trials) rather than for pilot or efficacy studies. A systematic review of the literature combined with qualitative interviews among cardiac arrest survivors was used to generate a list of potential outcome domains. This list was prioritized through a Delphi process, which involved clinicians, patients, and their relatives/partners. An international advisory panel narrowed these down to 3 core domains by debate that led to consensus. The writing group refined recommendations for when these outcomes should be measured and further characterized relevant measurement tools. Consensus emerged that a core outcome set for reporting on effectiveness studies of cardiac arrest (COSCA) in adults should include survival, neurological function, and health-related quality of life. This should be reported as survival status and modified Rankin scale score at hospital discharge, at 30 days, or both. Health-related quality of life should be measured with ≥1 tools from Health Utilities Index version 3, Short-Form 36-Item Health Survey, and EuroQol 5D-5L at 90 days and at periodic intervals up to 1 year after cardiac arrest, if resources allow.
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36
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Duchatelet C, Kalmar AF, Monsieurs KG, Hachimi-Idrissi S. Chest compressions during ventilation in out-of-hospital cardiac arrest cause reversed airflow. Resuscitation 2018; 129:97-102. [PMID: 29604395 DOI: 10.1016/j.resuscitation.2018.03.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 11/18/2022]
Abstract
AIM During cardiopulmonary resuscitation, once the patient is intubated, compressions and ventilations are performed simultaneously. Chest compressions during the inspiratory phase of ventilation may force air out of the lungs, causing so-called "reversed airflow", which may lead to ineffective ventilation. The purpose of this study is to determine the occurrence of this phenomenon and to quantify the volume of reversed airflow. METHODS Observational study. During manual ventilation of intubated patients receiving chest compressions, the pressure gradient over the endotracheal tube was measured using two air-filled catheters connected to a custom-made portable device. Chest compression data were measured using an accelerometer on a Zoll E- series defibrillator. All data are reported as mean (standard deviation; range). RESULTS Twenty-five patients and a total of 368 ventilations were studied, on average 15 (6; 10-30) per patient. The mean tidal volume, minute volume and ventilation rate were respectively 690 ml (160; 240-1260), 10.5 l/min (4.8; 4.4-22.1) and 18/min (6; 6-35). Reversed airflow was observed in 21/25 patients (84%) and in 65% of all ventilations, with on average two episodes per ventilation. Fifty-five percent of the chest compressions during the inspiratory phase of the ventilation generated reversed airflow. The mean volume of the reversed airflow was 96 ml per episode (52; 12-364). CONCLUSION Chest compressions during ventilation in intubated patients generated reversed airflow in most patients. There was wide variation in the number of episodes and volume of the reversed airflow between patients. The effect of this phenomenon on the efficacy of ventilation during resuscitation and on outcome needs further investigation.
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Affiliation(s)
- Christophe Duchatelet
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, B-9000, Ghent, Belgium; Department of Emergency Medicine, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Alain F Kalmar
- Department of Anaesthesia and Critical Care Medicine, Maria Middelares Hospital, Buitenring-Sint-Denijs 30, B-9000, Ghent, Belgium
| | - Koenraad G Monsieurs
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, B-9000, Ghent, Belgium; Department of Emergency Medicine, Antwerp University Hospital, Wilrijkstraat 10, B-2650, Edegem, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Universiteitsplein 1, B-2610, Wilrijk, Belgium
| | - Said Hachimi-Idrissi
- Faculty of Medicine and Health Sciences, Ghent University, Sint-Pietersnieuwstraat 25, B-9000, Ghent, Belgium; Department of Emergency Medicine, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium
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37
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Perkins GD, Olasveengen TM, Maconochie I, Soar J, Wyllie J, Greif R, Lockey A, Semeraro F, Van de Voorde P, Lott C, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation: 2017 update. Resuscitation 2017; 123:43-50. [PMID: 29233740 DOI: 10.1016/j.resuscitation.2017.12.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Gavin D Perkins
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium.
| | | | - Ian Maconochie
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jasmeet Soar
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jonathan Wyllie
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Robert Greif
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Andrew Lockey
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Federico Semeraro
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | | | - Carsten Lott
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Koenraad G Monsieurs
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
| | - Jerry P Nolan
- European Resuscitation Council, Emile Vanderveldelaan 35, BE-2845, Niel, Belgium
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38
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Perkins GD, Neumar R, Monsieurs KG, Lim SH, Castren M, Nolan JP, Nadkarni V, Montgomery B, Steen P, Cummins R, Chamberlain D, Aickin R, de Caen A, Wang TL, Stanton D, Escalante R, Callaway CW, Soar J, Olasveengen T, Maconochie I, Wyckoff M, Greif R, Singletary EM, O'Connor R, Iwami T, Morrison L, Morley P, Lang E, Bossaert L. The International Liaison Committee on Resuscitation-Review of the last 25 years and vision for the future. Resuscitation 2017; 121:104-116. [PMID: 28993179 DOI: 10.1016/j.resuscitation.2017.09.029] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 01/08/2023]
Abstract
2017 marks the 25th anniversary of the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1992 to create a forum for collaboration among principal resuscitation councils worldwide. Since then, ILCOR has established and distinguished itself for its pioneering vision and leadership in resuscitation science. By systematically assessing the evidence for resuscitation standards and guidelines and by identifying national and regional differences, ILCOR reached consensus on international resuscitation guidelines in 2000, and on international science and treatment recommendations in 2005, 2010 and 2015. However, local variation and contextualization of guidelines are evident by subtle differences in regional and national resuscitation guidelines. ILCOR's efforts to date have enhanced international cooperation, and progressively more transparent and systematic collection and analysis of pertinent scientific evidence. Going forward, this sets the stage for ILCOR to pursue its vision to save more lives globally through resuscitation.
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Affiliation(s)
- Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK.
| | - Robert Neumar
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Koenraad G Monsieurs
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Swee Han Lim
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Maaret Castren
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Jerry P Nolan
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Vinay Nadkarni
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Bill Montgomery
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Petter Steen
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Richard Cummins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Douglas Chamberlain
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Richard Aickin
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Allan de Caen
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Tzong-Luen Wang
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - David Stanton
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Raffo Escalante
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Clifton W Callaway
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Jasmeet Soar
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Theresa Olasveengen
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Ian Maconochie
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Myra Wyckoff
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Robert Greif
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Eunice M Singletary
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Robert O'Connor
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Taku Iwami
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Laurie Morrison
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Peter Morley
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Eddy Lang
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
| | - Leo Bossaert
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
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- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, UK
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Vissers G, Soar J, Monsieurs KG. Ventilation rate in adults with a tracheal tube during cardiopulmonary resuscitation: A systematic review. Resuscitation 2017; 119:5-12. [PMID: 28739281 DOI: 10.1016/j.resuscitation.2017.07.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/30/2017] [Accepted: 07/21/2017] [Indexed: 11/15/2022]
Abstract
AIM The optimal ventilation rate during cardiopulmonary resuscitation (CPR) with a tracheal tube is unknown. We evaluated whether in adults with cardiac arrest and a secure airway (tracheal tube), a ventilation rate of 10min-1, compared to any other rate during CPR, improves outcomes. METHODS A systematic review up to 14 July 2016. We included both adult human and animal studies. A GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to evaluate the quality of evidence for each outcome. RESULTS We identified one human observational study with 67 patients and ten animal studies (234 pigs and 30 dogs). All studies carried a high risk of bias. All studies evaluated for return of spontaneous circulation (ROSC). Studies showed no improvement in ROSC with a ventilation rate of 10 min-1 compared to any other rate. The evidence for longer-term outcomes such as survival to discharge and survival with favourable neurological outcome was very limited. CONCLUSION A ventilation rate recommendation of 10 min-1 during adult CPR with a tracheal tube and no pauses for chest compression is a very weak recommendation based on very low quality evidence.
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Affiliation(s)
- Gino Vissers
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium.
| | - Jasmeet Soar
- Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, United Kingdom
| | - Koenraad G Monsieurs
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
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40
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Nikolaou N, Castrén M, Monsieurs KG, Cimpoesu D, Georgiou M, Raffay V, Koster R, Hunyadi-Antičević S, Truhlář A, Bossaert L. Time delays to reach dispatch centres in different regions in Europe. Are we losing the window of opportunity? — The EUROCALL study. Resuscitation 2017; 111:8-13. [DOI: 10.1016/j.resuscitation.2016.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/19/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
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41
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Colliers A, Remmen R, Streffer ML, Michiels B, Bartholomeeusen S, Monsieurs KG, Goris J, Coenen S, Verhoeven V, Philips H. Implementation of a general practitioner cooperative adjacent to the emergency department of a hospital increases the caseload for the GPC but not for the emergency department. Acta Clin Belg 2017; 72:49-54. [PMID: 27748165 DOI: 10.1080/17843286.2016.1245936] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The implementation of general practitioner cooperatives (GPC) for out-of-hours (OOH) primary care, raises the question if the location of a GPC adjacent to a hospital reduces the OOH caseload of the emergency department (ED). METHODS Two natural experiments were used in this before-after study, the effect of the implementation of two GPCs in two different regions on the out-of-hours caseload of the local EDs was compared. One GPC was located adjacent to the ED of a general hospital, the other was not. GPCs (or rota systems) and EDs in comparable regions were selected as control groups during the same study period. The study was performed in Flanders (Belgium) with no gatekeeping function for general practitioners (GPs). RESULTS After implementation of the GPC there was a significantly increase in caseload at the GPC in the two regions, mainly due to an increase of consultations with small children. There were no significant changes in caseload at the ED services. Self-referrals' to the ED did not change significantly. For the GPs the number of home visits decreased during out-of-hours in one region. CONCLUSION In a country with no gatekeeping role for GPs, implementing a GPC increased the out-of-hours caseload of the GPCs. The caseload of the EDs stabilised during the study period.
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Affiliation(s)
- Annelies Colliers
- Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Marie-Luise Streffer
- Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Barbara Michiels
- Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Stefaan Bartholomeeusen
- Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Koenraad G. Monsieurs
- Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
- Emergency Department, Antwerp University Hospital, Edegem, Belgium
| | - Jef Goris
- General Practice Cooperative Antwerp North, Merksem, Belgium
| | - Samuel Coenen
- Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
| | - Hilde Philips
- Faculty of Medicine and Health Sciences, Department of General Practice – Primary and Interdisciplinary Care, University of Antwerp, Antwerp, Belgium
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42
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Böttiger BW, Bossaert LL, Castrén M, Cimpoesu D, Georgiou M, Greif R, Grünfeld M, Lockey A, Lott C, Maconochie I, Melieste R, Monsieurs KG, Nolan JP, Perkins GD, Raffay V, Schlieber J, Semeraro F, Soar J, Truhlář A, Van de Voorde P, Wyllie J, Wingen S. Kids Save Lives - ERC position statement on school children education in CPR.: "Hands that help - Training children is training for life". Resuscitation 2016; 105:A1-3. [PMID: 27339096 DOI: 10.1016/j.resuscitation.2016.06.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- B W Böttiger
- European Resuscitation Council (ERC), Niel, Belgium; Department of Anaesthesiology and Intensive Care Medicine, University Hospital and University of Cologne, Germany.
| | - L L Bossaert
- European Resuscitation Council (ERC), Niel, Belgium; University of Antwerp, Antwerp, Belgium
| | - M Castrén
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - D Cimpoesu
- European Resuscitation Council (ERC), Niel, Belgium; University of Medicine and Pharmacy Gr.T. Popa Iasi, Emergency Department - Emergency County Hospital Sf. Spiridon, Iasi, Romania
| | - M Georgiou
- European Resuscitation Council (ERC), Niel, Belgium; American Medical Center Cyprus, Nicosia University Medical School, Nicosia, Cyprus
| | - R Greif
- European Resuscitation Council (ERC), Niel, Belgium; Department of Anaesthesiology and Pain Therapy, University Hospital Bern and University of Bern, Switzerland
| | - M Grünfeld
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine, Prehospital Unit, Community Health Centre Kranj, Kranj, Slovenia
| | - A Lockey
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine, Calderdale and Huddersfield NHS Foundation Trust, Halifax, UK
| | - C Lott
- European Resuscitation Council (ERC), Niel, Belgium; Department of Anesthesiology, University of Mainz, Germany
| | - I Maconochie
- European Resuscitation Council (ERC), Niel, Belgium; Department of Paediatric Emergency Medicine, Imperial College NHS Healthcare Trust, Imperial College, London, UK
| | - R Melieste
- European Resuscitation Council (ERC), Niel, Belgium
| | - K G Monsieurs
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Belgium
| | - J P Nolan
- European Resuscitation Council (ERC), Niel, Belgium; Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | - G D Perkins
- European Resuscitation Council (ERC), Niel, Belgium; Warwick Medical School and Heart of England NHS Foundation, Warwick, UK
| | - V Raffay
- European Resuscitation Council (ERC), Niel, Belgium
| | - J Schlieber
- European Resuscitation Council (ERC), Niel, Belgium; AUVA Trauma Center Salzburg, Department of Anaesthesiology, Salzburg, Austria
| | - F Semeraro
- European Resuscitation Council (ERC), Niel, Belgium; Department of Anaesthesia and Intensive Care Medicine, Maggiore Hospital, Bologna Italy
| | - J Soar
- European Resuscitation Council (ERC), Niel, Belgium; Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol UK
| | - A Truhlář
- European Resuscitation Council (ERC), Niel, Belgium; Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University of Hradec Králové, Czech Republic
| | - P Van de Voorde
- European Resuscitation Council (ERC), Niel, Belgium; Department of Emergency Medicine, University of Ghent, Belgium
| | - J Wyllie
- European Resuscitation Council (ERC), Niel, Belgium; Department of Neonatology, James Cook University Hospital, Middlesbrough, UK
| | - S Wingen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital and University of Cologne, Germany.
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Kalmar AF, Absalom A, Rombouts P, Roets J, Dewaele F, Verdonck P, Stemerdink A, Zijlstra JG, Monsieurs KG. Automatic detection of oesophageal intubation based on ventilation pressure waveforms shows high sensitivity and specificity in patients with pulmonary disease. Resuscitation 2016; 105:36-40. [PMID: 27211837 DOI: 10.1016/j.resuscitation.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/09/2016] [Accepted: 05/15/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unrecognised endotracheal tube misplacement in emergency intubations has a reported incidence of up to 17%. Current detection methods have many limitations restricting their reliability and availability in these circumstances. There is therefore a clinical need for a device that is small enough to be practical in emergency situations and that can detect oesophageal intubation within seconds. In a first reported evaluation, we demonstrated an algorithm based on pressure waveform analysis, able to determine tube location with high reliability in healthy patients. The aim of this study was to validate the specificity of the algorithm in patients with abnormal pulmonary compliance, and to demonstrate the reliability of a newly developed small device that incorporates the technology. MATERIALS AND METHODS Intubated patients with mild to moderate lung injury, admitted to intensive care were included in the study. The device was connected to the endotracheal tube, and three test ventilations were performed in each patient. All diagnostic data were recorded on PC for subsequent specificity/sensitivity analysis. RESULTS AND DISCUSSION A total of 105 ventilations in 35 patients with lung injury were analysed. With the threshold D-value of 0.1, the system showed a 100% sensitivity and specificity to diagnose tube location. CONCLUSION The algorithm retained its specificity in patients with decreased pulmonary compliance. We also demonstrated the feasibility to integrate sensors and diagnostic hardware in a small, portable hand-held device for convenient use in emergency situations.
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Affiliation(s)
- Alain F Kalmar
- Department of Anesthesia and Intensive Care Medicine, Maria Middelares Hospital, Ghent, Belgium; Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Anthony Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pieter Rombouts
- Department of Electronics and Information Systems (ELIS), Ghent University, Gent, Belgium
| | - Jelle Roets
- Department of Electronics and Information Systems (ELIS), Ghent University, Gent, Belgium
| | - Frank Dewaele
- Department of Neurosurgery, Ghent University Hospital, Ghent, Belgium
| | - Pascal Verdonck
- Department of Electronics and Information Systems (ELIS), Ghent University, Gent, Belgium
| | - Arjanne Stemerdink
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan G Zijlstra
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Koenraad G Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium; Emergency Medicine, Ghent University, Gent, Belgium
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Verdonck P, de Schoutheete JC, Monsieurs KG, Van Laer C, Vander Poorten V, Vanderveken O. Penetrating and blunt trauma to the neck: clinical presentation, assessment and emergency management. B-ENT 2016; Suppl 26:69-85. [PMID: 29558578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Penetrating and blunt trauma to the neck: clinical presentation, assessment ana emergency management. In Belgium, and even in Western Europe, penetrating and blunt injury to the neck is relatively uncommon in both the civilian and military populations. Pre-hospital and emergency assessment and management will therefore always prove challenging, as individual exposure to this specific type of injury remains low. Historically, the neck has been divided into three anatomical zones with specific landmarks to guide the diagnostic and therapeutic approach to penetrating neck injuries. Most penetrating injuries need to be explored surgically, although with the advent of multi-detector computed tomographic angiography (MDCTA), which yields high diagnostic sensitivity, this inflexible approach has recently changed to a more targeted management, based on clinical, radiographic and, if deemed necessary, endoscopic findings. However, some authors have addressed their concern about this novel, 'no-zone' approach, since the risk of missing less apparent aerodigestive tract injuries may increase. It is recommended, therefore, that all patients with penetrating neck injuries be closely observed, irrespective of the initial findings. The incidence of blunt neck injury is much lower, and this makes risk assessment and management even more difficult in comparison with penetrating injuries. Again, MDCTA is most often the first diagnostic tool if a blunt neck injury is suspected, due to its good sensitivity for blunt cerebrovascular injuries (BCVI) as well as for aerodigestive tract injuries. Specific patterns of injury and unexpected neurological and neuro-radiological findings in trauma patients should always warrant further investigation. Despite ongoing debate, systemic anticoagulation is recommended for most BCVI, sometimes combined with endovascular treatment. Aerodigestive tract injuries may present dramatically, but are often more subtle, making the diagnosis more difficult than other types of neck injuries. Treatment may be conservative if damage is minimal, but surgery is warranted in all other cases.
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Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, Bossaert LL, Brett SJ, Chamberlain D, de Caen AR, Deakin CD, Finn JC, Gräsner JT, Hazinski MF, Iwami T, Koster RW, Lim SH, Ma MHM, McNally BF, Morley PT, Morrison LJ, Monsieurs KG, Montgomery W, Nichol G, Okada K, Ong MEH, Travers AH, Nolan JP. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest. Resuscitation 2015; 96:328-40. [DOI: 10.1016/j.resuscitation.2014.11.002] [Citation(s) in RCA: 388] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 564] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies KC, Zideman DA, Nolan JP, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015; 95:148-201. [PMID: 26477412 DOI: 10.1016/j.resuscitation.2015.07.017] [Citation(s) in RCA: 525] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic.
| | - Charles D Deakin
- Cardiac Anaesthesia and Cardiac Intensive Care, NIHR Southampton Respiratory Biomedical Research Unit, Southampton University Hospital NHS Trust, Southampton, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | | | - Annette Alfonzo
- Departments of Renal and Internal Medicine, Victoria Hospital, Kirkcaldy, Fife, UK
| | | | - Guttorm Brattebø
- Bergen Emergency Medical Services, Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bozen, Italy
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Rudolph W Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Lockey
- Intensive Care Medicine and Anaesthesia, Southmead Hospital, North Bristol NHS Trust, Bristol, UK; School of Clinical Sciences, University of Bristol, UK
| | - Carsten Lott
- Department of Anesthesiology, University Medical Center, Johannes Gutenberg-Universitaet, Mainz, Germany
| | - Peter Paal
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Anaesthesiology and Critical Care Medicine, University Hospital Innsbruck, Austria
| | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Claudio Sandroni
- Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy
| | | | - David A Zideman
- Department of Anaesthetics, Imperial College Healthcare NHS Trust, London, UK
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, UK
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Perkins GD, Travers AH, Berg RA, Castren M, Considine J, Escalante R, Gazmuri RJ, Koster RW, Lim SH, Nation KJ, Olasveengen TM, Sakamoto T, Sayre MR, Sierra A, Smyth MA, Stanton D, Vaillancourt C, Bierens JJ, Bourdon E, Brugger H, Buick JE, Charette ML, Chung SP, Couper K, Daya MR, Drennan IR, Gräsner JT, Idris AH, Lerner EB, Lockhat H, Løfgren B, McQueen C, Monsieurs KG, Mpotos N, Orkin AM, Quan L, Raffay V, Reynolds JC, Ristagno G, Scapigliati A, Vadeboncoeur TF, Wenzel V, Yeung J. Part 3: Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:e43-69. [DOI: 10.1016/j.resuscitation.2015.07.041] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Greif R, Lockey AS, Conaghan P, Lippert A, De Vries W, Monsieurs KG, Ballance JH, Barelli A, Biarent D, Bossaert L, Castrén M, Handley AJ, Lott C, Maconochie I, Nolan JP, Perkins G, Raffay V, Ringsted C, Soar J, Schlieber J, Van de Voorde P, Wyllie J, Zideman D. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:288-301. [DOI: 10.1016/j.resuscitation.2015.07.032] [Citation(s) in RCA: 272] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Soar J, Callaway CW, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, Donnino MW, Drajer S, Kloeck W, Morley PT, Morrison LJ, Neumar RW, Nicholson TC, Nolan JP, Okada K, O’Neil BJ, Paiva EF, Parr MJ, Wang TL, Witt J, Andersen LW, Berg KM, Sandroni C, Lin S, Lavonas EJ, Golan E, Alhelail MA, Chopra A, Cocchi MN, Cronberg T, Dainty KN, Drennan IR, Fries M, Geocadin RG, Gräsner JT, Granfeldt A, Heikal S, Kudenchuk PJ, Lagina AT, Løfgren B, Mhyre J, Monsieurs KG, Mottram AR, Pellis T, Reynolds JC, Ristagno G, Severyn FA, Skrifvars M, Stacey WC, Sullivan J, Todhunter SL, Vissers G, West S, Wetsch WA, Wong N, Xanthos T, Zelop CM, Zimmerman J. Part 4: Advanced life support. Resuscitation 2015; 95:e71-120. [DOI: 10.1016/j.resuscitation.2015.07.042] [Citation(s) in RCA: 214] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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